Data from: Endovascular treatment in older adults with acute ischemic stroke in the MR CLEAN Registry

Objective: To explore clinical outcomes in older adults with acute
ischemic stroke treated with endovascular thrombectomy (EVT). Methods: We
included consecutive patients (2014–2016) with an anterior circulation
occlusion undergoing EVT from the MR CLEAN Registry. We assessed the
effect of age (dichotomized at ≥80 years, and as continuous variable) on
the modified Rankin Scale [mRS] score at 90 days, symptomatic intracranial
hemorrhage (sICH), and reperfusion rate. The association between age and
mRS was assessed with multivariable ordinal logistic regression, and a
multiplicative interaction term was added to the model to assess
modification of reperfusion by age on outcome. Results: 380/1526 (25%) of
patients were 80 years or older (=older adults). Older adults had a worse
functional outcome than younger patients (adjusted common OR for an mRS
shift towards better outcome: 0.31, 95%CI 0.24–0.39). Mortality was also
higher in older adults (51% vs. 22%, aOR 3.12, 95%CI 2.33–4.19). There
were no differences in proportion of patients with mRS 4-5, sICH, or
reperfusion rates. Successful reperfusion was more strongly associated
with a shift towards good functional outcome in older adults than in
younger patients (acOR 3.22, 95%CI 2.04–5.10 vs. 2.00, 95%CI 1.56–2.57,
Pinteraction=0.026). Conclusion: Older age is associated with an increased
absolute risk of poor clinical outcome, while the relative benefit of
successful reperfusion seems to be higher in these patients. These results
should be taken into consideration when selecting older adults for EVT.